老年髋部骨折患者围术期血清白细胞介素-6、肿瘤坏死因子α和骨代谢指标水平与术后髋关节功能恢复的关系

Relationship between perioperative serum IL-6,TNF-α,bone metabolism indexes and postoperative recovery of hip function in elderly patients with hip fracture

目的探讨老年髋部骨折(HF)患者围术期血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α和骨代谢指标与术后髋关节功能恢复的关系。方法回顾性分析2019年5月至2022年5月咸阳市第一人民医院治疗的70例老年HF患者病历资料。根据恢复情况分为恢复良好组(38例)及恢复不良组(32例)。比较各组患者血清IL-6、TNF-α和骨代谢指标水平[骨碱性磷酸酶(BALP)、骨钙素(BGP)、骨保护素(OPG)]。采用斯皮尔曼相关性分析明确血清IL-6、TNF-α和骨代谢指标水平与老年HF术后髋关节功能恢复关系。结果IL-6、TNF-α的组间、时间点差异均有统计学意义(P<0.001),恢复良好组围术期各时间点IL-6水平均显著低于恢复不良组(P<0.05),恢复良好组术后第3天、第7天TNF-α水平均显著低于恢复不良组(P<0.05);BALP、BGP及OPG的组间、时间点差异均有统计学意义(P<0.001),恢复良好组围术期各时间点BGP、术后第7天BALP及术前1天、术后第7天OPG水平均显著高于恢复不良组(P<0.05);围术期各时间点IL-6及术后第3天、第7天TNF-α水平与髋关节功能恢复呈负相关(P<0.05);术后第7天BALP、OPG水平及各时间点BGP水平与髋关节功能恢复呈正相关(P<0.05)。结论围术期血清IL-6、TNF-α水平越高,髋关节功能恢复越差;围术期骨代谢指标水平越低,髋关节功能恢复越差。

Objective To explore the relationship between perioperative serum interleukin-6(IL-6),tumor necrosis factorα(TNF-α),bone metabolism indexes and postoperative recovery of hip function in elderly patients with hip fracture(HF).Methods A retrospective analysis was performed on the clinical data of 70 elderly patients with HF treated in the First People's Hospital of Xianyang between May 2019 and May 2022.According to recovery status,patients were divided into good recovery group(n=38)and poor recovery group(n=32).The levels of serum IL-6,TNF-αand bone metabolism indexes[bone alkaline phosphatase(BALP),osteocalcin(BGP),osteoprotegerin(OPG)]were compared in different groups.The relationship between serum IL-6,TNF-α,bone metabolism indexes and postoperative recovery of hip function in elderly HF patients was determined by Spearman correlation analysis.Results There were significant differences in IL-6 and TNF-αin terms of between-group dimension,time point dimension and interaction dimension(P<0.001).The level of perioperative IL-6 in good recovery group was significantly lower than that in poor recovery group(P<0.05),and TNF-αlevel was significantly lower than that in poor recovery group at 3rd day and 7th day after surgery(P<0.05).There were significant differences in BALP,BGP and OPG in terms of between-group dimension,time point dimension and interaction dimension(P<0.001).The levels of perioperative BGP,BALP at 7th day after surgery,and OPG at 1st day before surgery and 7th day after surgery in good recovery group were significantly higher than those in poor recovery group(P<0.05).The perioperative IL-6 and TNF-αat 3rd and 7th day after surgery were negatively correlated with the recovery of hip function(P<0.05),BALP,OPG and BGP levels at 7th day after surgery were positively correlated with it(P<0.05).Conclusions The higher the levels of serum IL-6 and TNF-αand the lower the level of bone metabolism indicators during the perioperative period,and influence negatively the recovery of hip joint function.